“It may not be the classic elephant sitting on my chest feeling. It could be more subtle,” said Dr. Holst. “And some people with diabetes don’t feel heart discomfort at all.”

The study can’t show it is the diabetes that causes the heart disease, but the link is well known.

“Men should not worry, now that women are more at risk than men. I think men and women should be conscious of making choices that would reduce risk of heart disease, especially in people who have diabetes,” says Dr. Holst.

For diabetics, keeping blood sugar, or glucose, in the normal range can help the eyes, kidneys and nerves, but not necessarily the heart.

But keeping cholesterol and blood pressure normal, regular exercise, cutting out tobacco, and in some cases, a daily aspirin, will reduce the risk.